Across Europe many older people in need of greater care and support are cared for at home; however, the majority of public and private expenditure is spent on residential care. For individuals level, out-of-pocket payments (OPP) can represent a sizeable share of an individual’s income. In most European countries, OPPs for residential care are income-related, but in some instances, assets or even relatives’ financial resources may be taken into consideration for the calculation of OPPs. These OPPs have potential implications for equity both for access – whether residential care is affordable – and financing – who contributes the most – of residential care.
Currently there is limited systematic information being collected on OPPs, its equity and policy implications. As a result the European Centre for Social Welfare Policy and Research have published a policy brief meant to fill the knowledge gaps on "the policy and equity implications of out-of-pocket payments (OPPs) on access and financing of residential care".
Some key messages of the policy brief include:
- The social assistance rationale is still prevalent in long-term care.
- Basing access to residential care on need may decrease barriers of accessibility.
- A lifelong cap on total OPPs paid by each individual could limit uncertainty.
- Redistributive mechanisms are needed to share the burden of financing more evenly between and within generations.